Provider Demographics
NPI:1225154651
Name:PATTEN, AMY BOARDMAN (NP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BOARDMAN
Last Name:PATTEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MICHGAN AVE NE
Mailing Address - Street 2:HEALTH AND WELLNESS CENTER
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-1004
Mailing Address - Country:US
Mailing Address - Phone:202-884-9613
Mailing Address - Fax:
Practice Address - Street 1:125 MICHGAN AVE NE
Practice Address - Street 2:HEALTH AND WELLNESS CENTER
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-1004
Practice Address - Country:US
Practice Address - Phone:202-884-9613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1009331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCQ79184Medicare UPIN